**Resp & Qualifications**

**PURPOSE:**
Investigate and perform adjustment of claims and ensure that claims are handled properly within authority limits, and in line with standard procedures and guidelines. Verifies insurance claims by reviewing claims requirements; examining documentation and calculations; highlighting and summarizing out-of-line situations; recommending changes in operating processes; completing reports, logs, and audit records.

**ESSENTIAL FUNCTIONS:**

+ Proactively investigate and perform adjustments of claims. Ensure claims are handled within authority limits, and in line with standard procedures and guidelines.
+ Updates claims audit records by entering, verifying, and securing data.
+ Settle standard/complex claims through payment or denial.
+ Provides claims audit information and reports by collecting, analyzing, and summarizing data and trends.
+ Improves claims adjustment job knowledge by attending training sessions.